History: 8yo African American female who presents with morning vomiting, wide-based gait, headache, and blurred vision
Her complaints began four to six weeks ago, and her pediatrician attributed her symptoms to a "viral syndrome", prescribing rest, fluids and Tylenol. Her vomiting is projective in nature, without associated nausea. It started only occasionally, but progressed to daily over the course of 3-4 weeks. Her headache is described as pancephalic, worse in the morning as well and not relieved by aspirin. She describes the blackboard at school as being "fuzzy". Her pre-natal course and delivery were unremarkable, and she has been in the 85th percentile on her growth curve. Developmental milestones wore reached at appropriate ages. She has done very well in school with an 89 average, but notes she does less well in gym class lately. There is a positive family history for cancer in her paternal grandmother and aunt, location and type unknown. Review of systems also reveals photophobia of three weeks duration. No meds, NKDA.

Findings: Contrast and Non-contrast study of the head: Turning attention to the non-contrast study first, the most striking finding is the extent of hydrocephalus, with dilatation of both lateral ventricles and third ventricle. Looking at images three and four, there is an obvious hyperdense mass in the posterior fossa in the midline, obliterating the fourth ventricle. There seems to be hypodense regions in the center of the mass, suggesting central necrosis or cyst. Compression of the brainstem anteriorly is also evident There is no evidence of calcification, and both internal auditory canals are normal, and there are no cortex lesions. The contrast exam shows enhancement of the mass in a uniform manner. Vascularity is otherwise normal.

History: 8yo African American female who presents with morning vomiting, wide-based gait, headache, and blurred vision
Her complaints began four to six weeks ago, and her pediatrician attributed her symptoms to a "viral syndrome", prescribing rest, fluids and Tylenol. Her vomiting is projective in nature, without associated nausea. It started only occasionally, but progressed to daily over the course of 3-4 weeks. Her headache is described as pancephalic, worse in the morning as well and not relieved by aspirin. She describes the blackboard at school as being "fuzzy". Her pre-natal course and delivery were unremarkable, and she has been in the 85th percentile on her growth curve. Developmental milestones wore reached at appropriate ages. She has done very well in school with an 89 average, but notes she does less well in gym class lately. There is a positive family history for cancer in her paternal grandmother and aunt, location and type unknown. Review of systems also reveals photophobia of three weeks duration. No meds, NKDA.

Findings: Contrast and Non-contrast study of the head: Turning attention to the non-contrast study first, the most striking finding is the extent of hydrocephalus, with dilatation of both lateral ventricles and third ventricle. Looking at images three and four, there is an obvious hyperdense mass in the posterior fossa in the midline, obliterating the fourth ventricle. There seems to be hypodense regions in the center of the mass, suggesting central necrosis or cyst. Compression of the brainstem anteriorly is also evident There is no evidence of calcification, and both internal auditory canals are normal, and there are no cortex lesions. The contrast exam shows enhancement of the mass in a uniform manner. Vascularity is otherwise normal.